Creating A Better Future For Kids: Permanente Medicine

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On The Next Big Thing in Health, hosts Laura Evans and AHIP President and CEO Matt Eyles sat down with Dr. Imelda Dacones, President & CEO of Northwest Permanente Medical Group to discuss how adverse childhood experiences impact our lives, what they mean for our long-term health and more.

Laura Evans: When it comes to social determinants of health, you say that the mindset really has to shift. Is it shifting toward what you’re talking about, is it shifting toward examining the whole patient as a whole from what’s happening in the home to the cough they present when they go to see the doctor?

Dr. Imelda Dacones: Well certainly within Kaiser Permanente, I believe there is more awareness about adverse childhood experiences, about the social determinants of health, and the fact that less than 20% of health outcomes come from what I do inside the clinic or the hospital.

The vast majority – over 80% – really come from social economic factors, from behavioral health, genetics, certainly the environment. With knowledge comes how do we reformulate our strategy to really do prevention when it’s very, very early.

Out of our center for health research at Kaiser Permanente, for example, moms – where we looked at intervening in terms of their lifestyle and diet – had better outcomes in terms of the birth weight of their children, in terms of propensity for developing diabetes in the child as well as within the mom. There’s a lot of data out there that shows that intervening early – in utero even – really impacts the well-being of the person.

Laura Evans: So Matt, Dr. Dacones spoke about how Northwest Permanente’s integrated model impacts doctors, hospitals, and health plans – aligning them all and setting high-quality, affordable care as their North Star.

I know you’ve worked in a variety of roles in the health care industry and have a deep understanding of the broader trends in the health care industry. In your opinion, do you agree with this trend toward greater integration?

Matt Eyles: Integration and the downstream impact on care coordination is incredibly important. I see it as a trend of the future. People are investing in different ways of delivering care, different capabilities. We want to think about people really as the whole person. What are their physical needs? What are their mental behavioral health needs? What are their pharmacy needs?

We shouldn’t be segregating these out into different silos. We really want to think about this as a whole person and what’s going to lead to the best outcome.

It also provides us some insight into the total cost of care and what’s really driving health care costs. Is it something that’s happening with respect to a behavioral health issue or a mental health issue? Is it really a chronic condition? Is it pharmacy? How can we make sure that we’re delivering the highest quality, most cost-effective care?

The only way to do that is to really think about the whole person and how you integrate it.